A cold climate for NICE?

The terms differ; dis investment, decommissioning, saving money, but as the National Institute for Health and Clinical Excellence noted at a recent meeting, whatever it’s called the National Health Service is facing an unprecedented financial challenge.

At the Institute’s recent Question Time and public Board Meeting earlier this month, its chief executive Andrew Dillon focused on what NICE is doing to help the NHS “cut costs, while at the same time maintaining and even improving services”, and he stressed that his organisation wants to be “side by side with the NHS” in these hard times, citing more than 600 sets of guidance for how the health service can best spend its money.

For one, Dillon highlighted the new dedicated web support available to the NHS, bringing together all the Institute’s cost saving help, including sections on: - Cost saving guidance, where NICE brings together its list of recommendations designed to save primary care trusts money, which it believes can collectively help generate savings of more than £600 million; - Spending to save, in which the Institute highlights the importance of its guidance on public health and demonstrates that public health interventions are very cost effective; - Costing tools, to help PCTs plan expenditure, including horizon scanning to inform commissioners the areas on which they are likely to have to spend cash on in the future; - Recommendation reminders, also known as ‘optimal practice reviews’, a list of reminders of ineffective practices that do not offer the NHS value for money. According to NICE, providers just need to carry out some simple audits to help achieve large cost savings whilst also making sure clinical practice is in line with best practice; and - Commissioning guides, which include advice on ‘how’ commissioners can commission in line with NICE guidance.

Although bringing together this material is likely to be helpful, there is little that is new. Commissioners still have to face the challenges of making change happen, and the spend to save ethos requires commissioners to be brave enough to splash more cash at a time when there is likely to be very little money about, and for returns that are likely to occur at a distant point in time in the future.

The cost watchdog is also focusing upon “optimising” resource use, which means providing advice that is targeted to those who are most likely to benefit. Dillon stressed that the majority of its recommendations arising from technology appraisals are optimised – or approved for restricted patient populations to ensure best use of resources. He said contrary to some people’s views, NICE did not say “just another big yes [to manufacturers of new medicines] it’s a very careful analysis”. He also pointed out that this optimisation is most often focused on the patients’ capacity to benefit, accounting for the vast majority of the restrictions in such optimised recommendations.

This ethos of optimisation also underpins the Institute’s other activities including the new programme of developing Quality Standards, a tool that Dillon hopes will allow providers to measure their own services, be a focus of dialogue between commissioners and providers, and aid discussions about deficits with local communities. A tall order for as yet undefined Quality Standards, which are also being rolled out slowly at 25 per year.

But what about the direct impact upon NICE from the predicted cold climate? NICE has yet to have its budget confirmed by the Department of Health for 2010/11. And although the Institute has been asked to take on even more, including a new assessment of diagnostics and devices, it’s not clear if funds will become available. NICE, just like the NHS, is having to make plans and act based on some assumptions about what the future holds for its own resources. But it is clear that the cost regulator itself is likely to feel some of the freeze.